Stanley Feld M.D.,FACP,MACE
Obesity is an important contributor to our nation’s declining health and increasing healthcare costs. Obesity precipitates the onset of chronic diseases such as Type 2 diabetes mellitus. Five percent of our population has Type 2 diabetes mellitus. That 5% of the population with Type 2 diabetes mellitus consume 15% of our healthcare dollar.
Why are we as a nation becoming more obese annually? The answer is complex and has multiple interrelated reasons. These multiple factors must be understood and dealt with in order to solve the problem of obesity and decrease our healthcare costs. Solving the problem of obesity would be a major step in repairing the healthcare system.
As physicians we are quick to blame the patient for eating more than they are burning. Simply put this is the reason people gain weight. Why are we eating more than we are burning in 2007 rather than 50 years ago?
In order to answer this important question we must understand the relationship of calories to weight gain. We must also appreciate the ease of accumulating calories and the difficulty in losing calories. We as a nation have become obsessed with dieting and dieting schemes. The success of diets has been minimal. There is no quick fix to obesity. We must under go a lifestyle change. Effective durable lifestyle changes will only occur if there is a cultural change in our food preparation in America
The arithmetic of weight loss is discouraging. In order to lose 2.2 lbs we must lose kilogram (1000 grams) of fat. Fat is very dense in calories. Each gram of fat is 9 calories as opposed to each gram of carbohydrate or protein which is 4 calories. 2.2 lbs (1000 grams) equal 9000 calories. In order to lose 22 lbs you would have to burn 90,000 calories more than you eat or eat 90,000 calories less than you burn.
Let’s assume we burn 1500 to 2000 calories per day due to our basal metabolic rate (BMR) and normal daily activity. The BMR and the expenditure of calories with activity of daily living varies depending on age, height, and weight.
Let’s say you burn 2000 calories per day and eat 1500 calories per day. You would lose 500 calories that day. As soon as you go into negative caloric balance most people lose some body tissue water. The water weight loss is a meaningless measure of weight loss. In two days at 500 calories a day you would lose 1000 calories and in 18 days you would loss 2.2 lbs or 9000 calories. It would take 180 days to lose 22 lbs on a diet of 1500 calories a day if you burn 2000 calories a day. Most people burn fewer than 2000 calories a day. It is very difficult to stay on a diet for one half year and only lose 22 pounds when you might need to lose 40 pounds.
This is the reason that the approach to weight loss has to be a lifestyle change. A lifestyle change must be permanent. It should result in eating less and exercising (burning) more than you eat.
If we were predisposed to Type 2 diabetes mellitus and lost the weight we would avoid the ravages of the disease and decrease the cost to the healthcare system.
It is not our fault that the nation overeats. Overeating or eating calorie dense food has much to do with the economics, and politics of food production. The food industry’s economics and politics have resulted in social conditioning and mind manipulations that have resulted in overeating. We have to say this has got to change if we are serious about our health and controlling our healthcare costs.